Alta mortalidade em infecções associadas a dispositivos: um estudo de coorte retrospectivo em UTI de um hospital universitário brasileiro (2022-2024)
DOI:
https://doi.org/10.18554/acbiobras.v9i00.8952Keywords:
Infecções relacionadas à assistência a saúde, Unidades de Terapia Intensiva, Resistência microbiana a medicamentos, Infecção cruzada, Infecções relacionadas a cateteresAbstract
Foi avaliado o impacto clínico, o perfil microbiológico, os padrões de resistência antimicrobiana e os desfechos clínicos das infecções relacionadas à assistência à saúde (IRAS) em unidades de terapia intensiva (UTIs) de um hospital universitário terciário brasileiro. Trata-se de um estudo observacional retrospectivo que incluiu pacientes adultos admitidos nas UTIs adulto, coronariana e neurológica entre 2022 e 2024, que desenvolveram IRAS bacterianas a partir do terceiro dia de internação. Dados epidemiológicos, microbiológicos e de desfechos foram obtidos de sistemas institucionais de vigilância. As associações entre variáveis clínicas e desfechos foram avaliadas por testes não paramétricos, teste do qui-quadrado ou exato de Fisher, e regressão de Poisson. Um total de 429 pacientes desenvolveu 656 episódios de IRAS. Predominaram infecções associadas a dispositivos, especialmente pneumonia associada à ventilação mecânica (34,8%), infecções de corrente sanguínea (17,5%) e infecções do trato urinário (17,1%). A mortalidade hospitalar global foi de 54,5% e esteve independentemente associada ao aumento da idade. Bactérias Gram-negativas foram os patógenos mais frequentes, destacando-se Pseudomonas aeruginosa, Klebsiella pneumoniae e Escherichia coli. Entre os isolados de K. pneumoniae, 48,9% foram produtores de ESBL e 22,3% produtores de KPC. Embora fenótipos resistentes tenham apresentado mortalidade numericamente maior, nenhuma associação independente foi observada após ajuste. As IRAS associadas a dispositivos representam um importante desafio nas UTIs e são predominantemente causadas por patógenos Gram-negativos, com padrões de resistência relevantes, observados especificamente em organismos como K. pneumoniae. A elevada mortalidade observada parece estar associada principalmente a fatores relacionados ao paciente, como a idade, e não apenas à resistência antimicrobiana.
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